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General NPI Number Information
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NPI Number | 1154076404
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Entity Type | Organization
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Legal Business Name | REVIVAL MEDICAL SUPPLIES, INC.
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 9550 WARNER AVE STE 250-09
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2800
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Country | US
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Telephone | 949-229-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 9550 WARNER AVE STE 250-09
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2800
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Country | US
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Telephone | 949-229-5703
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EMAD ALI
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Credential |
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Telephone | 347-391-2751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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